Provider Demographics
NPI:1407309271
Name:PATHAK, KIRTY (DDS)
Entity Type:Individual
Prefix:
First Name:KIRTY
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4617
Mailing Address - Country:US
Mailing Address - Phone:716-652-7080
Mailing Address - Fax:
Practice Address - Street 1:5007 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4617
Practice Address - Country:US
Practice Address - Phone:716-652-7080
Practice Address - Fax:716-206-0895
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0592231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program